NCC206014_NOI Application_20210127

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/30/2020 10:56:07 AM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 12/31/2020 4:24:53 PM (Review- Construction NOI 39942)
• The task was assigned to Garcia, Lauren V by round robin distribution 12/30/2020 10:56 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 1, 2021 5:00
PM 12/30/2020 10:56 AM
Submit by Selkane, Aziza 1/27/2021 9:36:31 AM (Payment Verification for NCC206014)
* Anthony Zollicoffer
• Selkane, Aziza assigned the task to Selkane, Aziza 1/27/2021 9:35 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: February 11, 2021 5:00
PM 12/31/2020 4:25 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting r No
an NOI that was r Yes
rejected before?
Previous Rejected 39938
NOI No.
Prior Reviewer Aana Gamble
Name
1a. Project Name * Glen Oaks Ph 1- Davidson County- DAVID-2021-020
1 b. Specific Lot This field may be used to list specffc lot numbers.
Numbers
1 c. Parcel ID List all R% associated w ith this project.
Number(s) (PIN) 11338H000001-113338H0000016
2. County* Davidson
3. Highway or Street Glen Oaks Drive
Address* Street name only is acceptable if no address nunber assigned yet
4. CityorTownship* Lexington
5. State * NC
6. Zip Code* 27292
7. Latitude* Enter the latitude in decinal degrees
35.8177
8. Longitude * Enter the longitude in decinal degrees (MJSTbe negative)
-80.2749
If you do not know the latitude and longitude coordinates for this project, you can search the location on this map of
North Carolina. Look for the coordinates in the bottom left corner.
9. Date to Begin* 11/15/2020
Estinated Construction Project Start late
10. Date to End * 03/15/2021
Estirrated Construction Project End late

11. SIC (Primary)* Residential, Single Family Houses (SFE) (1521)
Standard Industrial (aassification for Development
12. Acres to be 2.19
disturbed* (including off -site borrow and waste areas)
13. Total site area 2.19
(acres) *
14. Post- 0.63
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-DAVID-2020-Glen Oaks Ph 1- Davidson County- DAVID-2021-
Tracking ID 020
Assigned automatically
Below you must enter waterbody information for surface waters affected by this project. Please consult
DWR's Surface Water Classifications Map Viewer to find waterbody name and corresponding index number. Please
enter only immediate receiving waterbodies - not waters downstream of those unless the project extends there. You
may enter up to 3 waterbodies if needed.
15a. Receiving Michael Branch
Waterbody* Plarreof waterbody into which stormwater runoff will discharge
15b. Waterbody 12-113-3
Index No. * NCWaterbody Index Number
Stormwater V No
discharges will flow r Yes
to additional
wate rs *
16a. Is this project r Yes
subject to the NC r No, not subject to NC SPCA
Sediment Pollution
Control Act?*

B. Permittee Information
Part B. ^
Fbrnittee Inforrration - Legally Fbsponsible Entity and Individual
Important: The person who signs the NOI Certification Form and signs the Certification in Section E of this application
form should be the same person as listed in THIS SECTION, or an authorized responsible individual within the same
organization. That person must be a responsible corporate officer who owns or operates the construction activity, such
as a president, secretary, treasurer, or vice president, or a manager that is authorized in accordance with Part IV,
Section B, Item (6) of the NCG010000 General Permit. For more information on signatory requirements, see Part
IV, Section B, Item (6) of that permit.
1. Organization Legally Pesponsible Entity
Name * WJH LLC
IF pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
Note: The organization name must match the business entity name registered with the NC Secretary of State. You can
verify the registration here.
2. First Name * Dave
IF Corporation, enter Faegistered Agent First Wre
3. Last Name* Hodgman
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title Regional President
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-302-1792
Telephone No.*
6. Permittee Mailing Street Address
Address* 3091 Governors Lake Dr, Ste 200
Address Line 2
City
Norcross
Fbstal / Zip Code
30071
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
F Yes
Street Address
3091 Governors Lake Dr, Ste 200
Address Line 2
city
Norcross
Fbstal / Zip Code
30071
State / Frovince / Fbgion
GA
Country
United States
State / Frovince / Faegion
GA
Country
United States
8. Type of Ojvnership is only individual if an individual is naned in B.1. above.
Ownership* Non -Government

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
...........................................................................................................................................................................................................................................................................
1. Primary Site Wayne
Contact - First
Name *
2. Primary Site McCormick
Contact - Last
Name *
3. Title Construction Manager
4. Site Contact E- [e-mail]
mail Address* m
5. Site Contact 336-549-8850
Telephone No.*
6. Organization WJH LLC
Name
7. Site Contact Street Address
Mailing Address* 1225 Eastchester Dr
Address Line 2
City State / Province / Region
Highpoint North Carolina
Postal / Zip Code Country
27265 USA
8. Consultant Name (Optional)
Anthony Zollicoffer
First and Last nacre
9. Consultant E-mail [e-mail]
This person will be copied on all correspondence.
10. Consultant 919-302-1792
Telephone No.
11. Billing E-mail (For Annual Fee correspondence)
Default is legally responsible person e-n-ail (older NCAs rray not populate)
12. Billing (For Annual Fee correspondence)
Telephone Default is legally responsible person telephone (older NOls rray not populate)

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 12/18/2020
Approved *
2. E&SC Plan Project DAVID-2021-020
Number/ID * Assigned by agency or local program
3. E&SC Plan r State DEQ Office
Approved by* r Local Program
4. State DEQ Office * Winston-Salem (WSRO)
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application. Please also upload a site map showing the overall extent of the project (for linear projects, can
include the beginning point and end point coordinates in the "Notes" box below).
5. E&SC Plan Glen Oaks Phase 1 Lot Erosion Control Permit.pdf 3.93MB
Approval letter or Mast beRDFforml
Grading Permit
6. Site Location Map Mast be RDFfornat (lint 20IVB)
GLEN OAKS PHASE 1 LOT EROSION CONTROL
2.37MB
PLAN.pdf
Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded documents support
the application. Include additional w aterbodies if necessary.
8. NOI Certification NCG01-eNO1-Certification-Form-20201210-DEMLR-
Form 856.58KB
SW (002)- Glen Oaks.pdf
%st be RDFfornat
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.66 (1) provides that:
Any person who knowingly makes anyfalse statement, representation, or certification in any application, record, report, plan, or other
document filed or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this Artcle; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
Commission implementing this Artcle shall be guilty ofa Class 2 misdemeanor which may include a fine not to exceed ten thousand
dollars ($10,000).
Under penalty of law, I certify that:
17 I am the person responsible for the construction activities of this project, for
satisfying the requirements of this permit, and for any civil or criminal penalties
incurred due to violations of this permit.
rJ The information submitted in this NOI is, to the best of my knowledge and belief,
true, accurate, and complete based on my inquiry of the person or persons who
manage the system, or those persons directly responsible for gathering the
information.
* 17 I will abide by all conditions of the NCG010000 General Permit and the
approved Erosion and Sediment Control Plan.
* rJ I hereby request coverage under the NCG010000 General Permit and
understand that coverage under this permit will constitute the permit
requirements for the discharge(s) and is enforceable in the same manner as an
individual permit.
Specify if you are:* r The Legally Responsible Person named on this Notice of Intent
r Authorized Responsible Person* (signing on behalf of Legally Responsible
Person named in Part B)
Important: The person who electronically signs this Certification above must be the same person who signs the NOI
Certification Form. If that person is signing on behalf of the Permittee, that individual must be an authorized responsible
person within the same organization as the Permittee. *An authorized individual is a responsible corporate officer who
owns or operates the construction activity, such as a president, secretary, treasurer, or vice president, or a manager
that is authorized in accordance with Part IV, Section B, Item (6) of the NCG010000 General Permit. For more
information on signatory requirements, see Part IV, Section B, Item (6) of that permit.
Signature
Type Name* Anthony Zollicoffer
Title Permit Coordinator
Organization Legally Plesponsible Entity
WJH LLC
Date * 12/30/2020

F. Tracking and COC Info
NOI Tracking No. 39942
NC Reference No.
NCG01-2020-6014
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC206014
Coverage (COC)
Uses 'count number' variable (increrrented by SP)
No.*
Count Number 6014
Sequential nurrber for subrrittal that is incremented by Stored Frocedure
COC Year 2020
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)
Initial Invoice No. NCC206014-2020
Invoice Due Date 1/30/2021
Initial Fee $ 100.00
Invoice Status OPEN